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4 - misc > ooh surgery wow > Flashcards

ooh surgery wow Flashcards

1
Q

What is body dysmorphobia?

A

Pt has a preoccupation with a defect of appearance
This leads to significant distress
Leads to associated mental disorders eg - anorexia nervosa
If pt isn’t happy with their face - orthognathic surgery won’t help them

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2
Q

Who is involved in the MDT for orthognathic surgery?

A

Psychologist
Orthodontist
Maxillofacial surgeon
Technologies
Restorative dentist
SLT

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3
Q

What should be considered in history for orthognathic surgery?

A

Congenital cause
Acromegaly - hormone with adenoma in pituitary
Pathology - cysts and tumours
Racial characteristics - don’t need to be changed
Psychological motivation

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4
Q

What 3 points of reference must be recorded on a facebow?

A

Condylar heads
Orbitale
Maxillary dentition

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5
Q

How is 3D planning carried out for orthognathic surgery?

A

Soft tissues imaging - stereophotogrametry
Skeletal tissue - CBCT
Dental tissue - intra-oral scan
All compiled together for a pt image

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6
Q

What maxillary problems may need orthognathic surgery?

A

Prognathic or retrognathic
Vertical excess or deficiency
Narrow or wide
Asymmetry

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7
Q

What mandibular problems may need orthognathic surgery?

A

Prognathic or retrognathic
Asymmetry

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8
Q

What chin problems may need orthognathic surgery?

A

Progenia or retrogenia
Vertical deficiency or excess
Asymmetry

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9
Q

What are the stages of tx before and after orthognathic surgery?

A

Tooth alignment, eliminate crowding spaces and crossbites
Coordination of arches
Decompensation of incisors (correcti inclination)
Flatten occlusal plane
Surgical fixation
Post-surgical ortho fine-tuning

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10
Q

What orthognathic surgeries can be carried out for the maxilla?

A

Le Fort I osteotomy
Anterior maxillary osteotomy
Posterior maxillary osteotomy

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11
Q

What is a Le Fort I osteotomy?

A

Disarticulating maxilla from base of skull and move it to a pre-planned position
Moves superiorly, inferiorly and forward
Cannot be moved posteriorly due to pterygoid plates

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12
Q

What orthognathic surgery is carried out for the mandible and what are the steps?

A

Sagittal split mandibular osteotomy
Separate the ramus from the body
Body can be moved in any direction

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13
Q

What orthognathic surgery is carried out for the chin and what are the steps?

A

Genioplasty
Inferior border of the mandible can move in any direction
Advancement, set-back and rotation
Augmentation and reduction

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14
Q

What are the signs and symptoms of mandibular fracture?

A

Pain, swelling, limitation of function
Occlusal derangement
Numbness of lower lip
Mobile teeth
Bleeding
Anterior open bite
Facial asymmetry
Deviation of the mandible to the opposite side
Step deformity

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15
Q

How do the muscles cause mandibular displacement?

A

Muscles work in opposite directions
Masseter, temporalis and medial pterygoid elevate the mandible and geniohyoid and anterior belly of digastric depress the mandible

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16
Q

How are mandibular fractures classed based on surrounding tissue involvement?

A

Simple - soft tissue intact
Compound - affects surrounding soft tissue
Comminuted - bone broken into multiple small pieces

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17
Q

What are the different sites of mandibular fracture?

A

Angle
Subcondylar
Parasymphyseal
Body
Ramus
Coronoid
Condylar (intra or extra capsular)
Alveolar process

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18
Q

How are mandibular fractures classed based on the direction of the fracture line?

A

Favourable - minimises displacement
Unfavourable - encourages displacement

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19
Q

What factors cause mandibular displacement?

A

Direction of fractures line
Opposing occlusion
Magnitude of force
Mechanism of injury
Intact soft tissues
Other associated fractures

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20
Q

What radiographs are used in mandible fractures?

A

PA mandible and OPT - right angles to each other
CBCT

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21
Q

How are mandibular fractures treated?

A

Control pain and infection
Reduction - putting segments in correct anatomical position
Fixation

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22
Q

What are the options for fixation?

A

Closed reduction and fixation (IMF)
ORIF - open reduction and internal fixation

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23
Q

What is the difference between open and closed reduction?

A

Open - expose bony areas surgically and reduce them directly with vision - most common
Closed - don’t open the fracture, you depend on the occlusion to guide the fracture into the correct alignment

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24
Q

What are the 5 surgical approaches for mandibular fractures?

A

Retro-mandibular approach
Raised on approach from inferior border
Pre auricular approach
Bicoronal flap - from one ear to the other
Endoscopic reduction and fixation

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25
Q

What is a step deformity?

A

An irregularity in the alignment of adjacent bone segments causing a visible or palpable step-like change in the bone contour
Sign of mandibular fracture

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26
Q

What is often used for Xenografts?

A

Bio-Oss
(Deproteinised bone matrix)

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27
Q

What are the principles of grafting?

A

Osteoconduction - the concept of scaffold that supports the bone forming cells
Osteoinduction - osteogenesis is induced through the recruitment of immature cells for bone formation

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28
Q

What local sites are used for bone grafting?

A

Chin
Ramus
Tuberosity
Coronoid process

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29
Q

What distant sites are used for bone grafting?

A

Iliac crest
Calvarium

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30
Q

What is the advantage of Bio-Oss?

A

Minimises resorption

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31
Q

What is applied after Bio-Oss?

A

GTR
Guided tissue regeneration membrane

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32
Q

What is an inter-positional graft?

A

Bone graft applied between inner and outer cortex to increase bone width

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33
Q

What is distraction osteogenesis?

A

Cutting bone (osteotomy), separating it to create a gap and then stretching the soft tissue to form bone from within

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34
Q

What are the steps of distraction osteogenesis?

A

Osteotomy
Latency - waiting for inflammatory cells to infiltrate and for soft tissue healing
Distraction (lengthening)
Consolidation - leave device in to hold bone in place
Bone remodelling

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35
Q

How is lengthening carried out in distraction osteogenesis?

A

Using a device, a key is turned so there is 1mm movement per day, 0.5mm in the morning, 0.5 in afternoon

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36
Q

Why os 1mm the max movement per day in distraction osteogenesis?

A

Any more would result in fibrous healing

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37
Q

What are the indications for zygomatic implants?

A

Severe maxillary atrophy
Sinus pneumatisation (increase in volume)
Avoids harvesting of bone graft
Hemimaxillectomy

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38
Q

What is BMP and how does it work?

A

Active osteoinductive factor
Extra-cellular protein stored in bone matrix
Contains cytokines that convert immature cells into osteoblasts stimulating bone formation

39
Q

How are maxillofacial fractures classed?

A
  1. Naso ethmoidal
  2. Lateral middle third (zygomatic)
  3. Central middle third
  4. Mandibular
40
Q

What are the different central middle third fractures?

A
  1. Nasal bone
  2. Unilateral maxillary fracture
  3. Le Fort 1
  4. Le Fort II
  5. Le Fort III
  6. Combinations
41
Q

What makes up the orbito nasal ethmoid complex?

A

Anterior wall
Medial wall
Lateral wall
Floor
Apex
Roof

42
Q

What is found in the medial wall of the orbito nasal ethmoid complex?

A

Medial rectus
Nose
Lacrimal duct and sac
Medial canthal ligament
Ethmoid sinus
Cribriform plate

43
Q

What is in the superior orbital fissure?

A

CN III
CN IV
CN VI
Ophthalmic nerve branches
Ophthalmic veins

44
Q

What is in the inferior orbital fissure?

A

Infraorbital nerve
Infraorbital vein
Infraorbital artery

45
Q

What are the signs of Malar (zygomatic) fractures?

A

Periorbital bruising
Subcutaneous emphysema
Epistaxis
Step deformity
Infraorbital sensory deficit
Diplopia

46
Q

How are orbito nasal ethmoid injuries managed definitively?

A

Review once swelling subsided
Further radiographs, possible CT
Informed consent
Closed reduction and possibly fixation
ORIF

47
Q

Why would a zygomatic fracture cause limited mouth opening?

A

It’s impinging on the coronoid process

48
Q

What approaches can be used for zygomatico orbital fractures to reduce scarring?

A

Howard Gillies approach
Trans-conjunctival approach
Bi-coronal approach

49
Q

What is found in the floor of the orbit?

A

Infraorbital nerves and vessels
Antrum
Nasolacrimal canal
Inferior rectus and oblique muscles

50
Q

What are the signs of floor of orbit fracture?

A

Enophthalmos - posterior displacement of eyeball
Diplopia
Infraorbital numbness
Antro-orbital communication
Naso-lacrimal duct damage

51
Q

What anatomy is found in the lateral orbit wall?

A

Lateral canthal ligament and muscle
CNVI
Lateral rectus
Middle cranial fossa
Dura and temporal lobe

52
Q

What are the signs of lateral wall fracture of the orbit?

A

Exophthalmos - protrusion of eyeball
Inward displacement
Lateral canthal displacement
Lateral rectus palsy

53
Q

What anatomy is found in the roof of the orbit?

A

Anterior cranial fossa
Dura and frontal lobe
Superior rectus and oblique
Frontal sinus
Supraorbital nerve

54
Q

What are the signs of orbital roof fracture?

A

Dural tear and brain damage
CSF leak
Trochlear damage
Diplopia
Frontal anaesthesia
Exophthalmos

55
Q

What anatomy is found at the apex of the orbit?

A

Optic nerve
Ophthalmic nerve and artery

56
Q

What are the signs of apex fracture?

A

Blindness

57
Q

What are the signs of medial wall fracture?

A

Nasal shortening
Bridge depression
Telecanthus
Diplopia
CSF leak
Cribriform plate damage
Naso-lacrimal apparatus damage
Medial displacement of eyeball

58
Q

How are trauma cases assessed?

A

A - airway and C spine control
B - breathing
C - circulation and haemorrhage control
D - disability (head injuries, GCS)

59
Q

What are the reasons for treating fractures?

A

Aesthetics
Prevent wound infection
Chronic sinusitis (up to 60% chance)
Meningitis (6%)
Mucoceles
Cavernous sinus thrombosis
Encephalitis
Brain abscess

60
Q

What are the aims of midface trauma treatment?

A

Create a safe sinus
Restore appearance

61
Q

What are the indications of surgery in midface trauma?

A

Anterior table displacement with forehead deformity
Displacement of posterior table with neurological injury
Frontonasal duct involvement
Non-surgical intervention for CSF leak to mitigate need for surgery

62
Q

What special investigations are needed for a frontonasal duct injury?

A

CT
Endoscopy
Methylene blue on table

63
Q

How is surgery carried out for a duct injury with a cosmetic defect?

A

Expose sinus lining and scrape in out
Remove inner table to cranialise the sinus
Block the duct with bone and tissu
Reconstruct the outer table
Aim to obliterate sinus cavity and obstruct duct outflow

64
Q

How should a GDP manage facial trauma?

A

Be fast
Analgesics
Antibiotics for open fractures
Liquid diet
Immediate discussion with oral maxillofacial surgery (OMFS) team

65
Q

What are the signs of midface and zygoma fractures?

A

Epistaxis
CNV2 numbness
Subconjunctival bleed
Midface mobility
Malocclusion
Periorbital emphysema
Diplopia
Facial asymmetry
CSF leak

66
Q

What are the indications to treat cranio-orbital trauma?

A

CSF leak
Deformity
As part of facial reconstruction

67
Q

What is a class I Le Fort fracture?

A

Horizontal separation of the maxilla from the rest of the facial skeleton

68
Q

What is a class II LeFort fracture?

A

Pyramidal fracture - triangular shaped separation of the central face from the rest of the skull

69
Q

What is a class III LeFort fracture?

A

Most severe - complete separation of the midface from the base of the skull

70
Q

What instructions should a GDP give to pts with a zygomatic fracture?

A

No need for ABs
Call OMFS - will be followed up 7-10 days
No nose blowing
Soft diet for comfort
Give warning of a retrobulbar bleed

71
Q

Give 4 examples of TMJ diseases

A

TMD
Jaw dislocation
Osteoarthritis
Ankylosis

72
Q

What are the components of TMD?

A

Muscular
Mechanical - the joint
Psychological - underlying cause
Trauma - aetiology

73
Q

What are the components of TMD aetiology?

A

Macrotrauma
Microtrauma - chronic joint overloading
Occlusal factors - eg deep bite, occlusal disharmony
Anatomical factors

74
Q

Why is the bilaminar zone important?

A

Resists the force of the lateral pterygoid preventing the articular disc from displacing

75
Q

What is anterior disc displacement without reduction?

A

When the articular disc is displaced anteriorly but does not reduce back to its original provision upon opening and closing the jaw

76
Q

What is anterior disc displacement with reduction?

A

Anterior displacement of the TMJ which reduces back into the normal position upon closing the jaw

77
Q

Give examples of conservative TMD management

A

Counselling
Pt education
Medications - NSAIDs tricyclic antidepressants
Pain management
Joint rest - soft diet
Bite raising appliance
Physical therapy

78
Q

What are the functions of a bite raising appliance?

A

Eliminates occlusal interferences
Prevents the joint head from rotating so far posteriorly in the glenoid fossa
Recudes loading on the TMJ

79
Q

What is an arthrogram and why is it used?

A

Imaging technique where radiopaque material is injected around the condyle to look at the upper and lower compartment of the TMJ

80
Q

Why is an MRI useful for TMD?

A

It shows the surrounding soft tissues and muscles of mastication well

81
Q

What is arthroscopy and why is it useful?

A

Minimally invasive procedure where an arthroscope is inserted into a joint to look for abnormalities
Good for detecting synovial membrane degeneration

82
Q

What procedures can be done through arthroscopy?

A

Diagnosis
Biopsy
Lysis and lavage
Disc reduction
Eminectomy

83
Q

What is arthrocentesis?

A

Alllowing washout of the joint space to remove inflammatory exudate

84
Q

List 8 complications of TMJ surgery?

A

Broken instruments
Middle ear perforation
Haemorrhage
Haemarthrosis
Damage to CNV and CNVII
Infection
Extravasion
Malocclusion

85
Q

What is disc plication?

A

Recapturing the disc and putting it back into place

86
Q

What is an eminectomy?

A

Removal of the articular eminence

87
Q

What is a high condylar shave?

A

Shaving the top of the condyle

88
Q

What is a condylotomy?

A

Creating a cut within the area of the condyle

89
Q

What is a meniscectomy?

A

Removal of the articular disc

90
Q

What is a condylectomy and when is it carried out?

A

Removing the entire condyle
Eg - if tumour of big degenerative change or ankylosis of joint

91
Q

What are the indications of TMJ reconstruction?

A

Joint destruction
Ankylosis
Developmental deformity
Tumours

92
Q

Name 6 surgical TMJ procedures?

A

Disc plication
High condylar shave
Eminectomy
Meniscectomy
Condylotomy
Condylectomy

93
Q

What is needed for a midface trauma diagnosis and what is commonly seen?

A

CT scan:
- anterior table
- posterior table
- frontonasal duct
- degree of displacement
- brain injury or bleed

4 - misc (10 decks)

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